Bree Collaborative Meeting January 15 th , 2020 | Puget Sound Regional Council
Agenda Welcome and Introductions Chair Report and Meeting Minutes Action Item: Approve minutes Clinical Information Exchange in Washington State Cascade Care Final Adoption: Risk of Violence to Others Action Item: Final Adoption Final Adoption: Maternity Bundle Action Item: Final Adoption BREAK Retreat Next Steps and Close Slide 2
November 20 th Meeting Minutes Slide 3
Behavioral Health Integration Initiative Kitsap Medical Group – Bremerton Community Health Centers of Snohomish County International Community Health Services – Shoreline Children’s Clinic at Harborview - Seattle Highline Medical Services Organizations Marysville Family Medicine Nisqually Tribal Health Clinic Harbor Medical Group – Aberdeen Snoqualmie Ridge Medical Clinic Family Health Centers – Brewster Confluence Health – Wenatchee Pullman Family Medicine Slide 4
Behavioral Health Integration Checklist Slide 5
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Applying Clinical Information to Improve Health Care Quality A Little Bit About OneHealthPort 1 The Emerging Clinical Information Space 2 Opportunities for Bree – Today and Tomorrow 3 7
Created in 2002, by and for the local healthcare community, OneHealthPort solves information exchange and workflow problems shared across healthcare organizations • Collaborative, open to all, transparent and neutral • Public/Private Partnership Built on Lead Organization • Filling the gaps, leveraging Shared Capabilities 8
Clinical Information Space Making progress – no longer have to rely solely on claims, able to leverage clinical data streams for multiple purposes 9
Changing Incentives Migration away from FFS makes clinical data of all Moving Maturing types more valuable to the Cloud Standards Economies/tools Documents (CCD) for smaller and queries National organizations (API/FHIR) Influences Networks, regulations and consolidated entities 10
How useful are standard clinical information documents for Quality Improvement? • OneHealthPort worked with OB COAP to assess ability to populate OB COAP data dictionary • Eligibility data, CCDs, discharge summaries got to 88% – adding claims got it up to 96% Then comes the key step – application of intelligence 11
Opportunities Today and Tomorrow What do you want to know? What questions do you want to answer? 12
A Quality Improvement “Platform” Transactions Collect Normalize Match Store clinical clinical patient and route data data identity data • Dashboard • Inquiry Analysis • Sandbox Applying clinical information to help answer questions about quality and health – OneHealthPort capabilities are one example 13
A Quality Improvement Platform Transactions Collect Normalize Match Store clinical clinical patient and route data identity data data • Dashboard • Inquiry Analysis • Sandbox • OneHealthPort has connected to many of the major WA clinical organizations for CCD exchange • There are over 13,000,000 CCDs in the Clinical Data Repository • CCD exchange currently limited to Medicaid Managed Care patients 14
A Quality Improvement Platform Transactions Collect Normalize Match Store clinical clinical patient and route data identity data data • Dashboard • Inquiry Analysis • Sandbox • Linking patient records is an industry wide-challenge • OneHealthPort has a Master Person Index (MPI) to help link records • MPI currently populated with payer (Medicaid) eligibility data to improve match rates 15
A Quality Improvement Platform Transactions Collect Normalize Match Store clinical clinical patient and route data identity data data • Dashboard • Inquiry Analysis • Sandbox OneHealthPort purchases data improvement services from Diameter Health 16
A Quality Improvement Platform Transactions Collect Normalize Match Store clinical clinical patient and route data identity data data • Dashboard • Inquiry Analysis • Sandbox Reduces significant levels of variation across submitters 17
A Quality Improvement Platform Transactions Collect Normalize Match Store clinical clinical patient and route data identity data data • Dashboard • Inquiry Analysis • Sandbox Normalized, matched records are stored centrally and can be routed either for: • Transactional use – care/management of individual patients by providers/plans (not our focus today) • Analytical use – understanding of correlation and trends across a population 18
A Quality Improvement Platform Transactions Collect Normalize Match Store clinical clinical patient and route data identity data data • Dashboard • Inquiry Analysis • Sandbox • Dashboard – examining results/trends using de-identified data • Inquiry – diving into the detail on specific identified patients or populations • Sandbox – services that support direct access to the data base 19
An example MENDS Pilot in Washington WA DOH, HCA, OneHealthPort, collaborating on deployment of MENDS (Multi-state EHR- Based Network for Disease Surveillance) WA pilot Go live: Q1 2020 20
An example MENDS Pilot in Washington • To support public health professionals in tracking chronic disease • OneHealthPort deploying revised MENDS tools in Azure Cloud • 1st phase, leverage Medicaid CCDs normalized through Diameter, to populate Dashboard • Future phases likely to focus on inquiry capabilities and additional conditions 21
An example MENDS Pilot in Massachusetts Application of intelligence to clinical data – in this case to enable public health surveillance From presentation by Michael Klompas MD, MPH, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute to 22 National Academy of Medicine, Digital Learning Collaborative, July 13, 2017
An example MENDS Pilot in Massachusetts Dashboard tool for viewing de-identified data From presentation by Michael Klompas MD, MPH, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute to 23 National Academy of Medicine, Digital Learning Collaborative, July 13, 2017
What would a Bree Quality Improvement Dashboard look like? Any interest in a pilot? – HCA asking OneHealthPort to explore opportunities for applying clinical data to assist Bree and other FHCQ programs 24
What’s on the horizon for tomorrow? 1. Moving beyond 2. Consumer facing 3. Event driven Medicaid – adding services – exploring a architecture – subscribe more CCD’s and lives community solution to a topic, get notified 25
Intellectual Leadership Market Readiness Technical Capabilities Transactions Collect Normalize Match Store clinical clinical patient and route data data identity data • Dashboard • Inquiry Analysis • Sandbox 26
Cascade Care Leah Hole-Marshall, WA Health Benefit Exchange & Rachel Quinn, WA Health Care Authority Bree Collaborative January 15, 2020
Agenda Background Standard plan designs for Cascade Care HCA contract and procurement role in Cascade Care Proposed Cascade Care purchasing standards and HCA approach Timeline and next steps Affordability requirements Q&A 28
Health Coverage in Washington Roughly 400,000 WA residents remain uninsured Office of Financial Management Forecasting & Research Division 29
Washington State Exchange Individual Market Overview OIC Geographic Rating Regions and 2020 Number of Carriers by County offered on the Exchange Number of Carrier(s) per county 2019 Exchange Individual Market Enrollment By Carrier and Total 30
Market Challenges: Instability Federal Action WA Proposed or Final Response Limit open enrollment period State response: Extend Open Enrollment and use and reduce ACAmarketing state funding for marketing Cost-sharing reduction (CSR) State response: Allow carriers to build cost of payments to carriers CSR’s into silver plan premiums terminated Expanding short-term limited State response: OIC rules to limit STLD medical duration (STLD) insurance policies plans to 3 months. Minimum standards set. Zeroing out of individual State mandate proposed in 2018 and 2019 mandate penalty session – not successful Discontinuation of federal State reinsurance program proposed in 2018 session reinsurance program - Not successful based on financing Expand association health plans OIC emergency rules and WA in multi-state legal challenge. Allow use of HRA to pay for Under review. individual health plans Repeal non-discrimination rule Existing WA State law does not allow discrimination (Section 1557) based on gender identity. Public Charge Rule and WA leads multi-state legal challenge. Presidential Proclamation 31
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Affordability at Risk Significant Premium Increases for Non-Subsidized • Nearly 60k Enrollees in Plan with >$9k Deductible • 37% of consumers who dropped coverage reported that it didn’t meet their budget 33
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